Thesis (Ph.D)--Public Policy, Georgia Institute of Technology, 2009. / Committee Chair: Theodore H. Poister, Ph.D.; Committee Member: Gordon Kingsley, Ph.D.; Committee Member: John Thomas, Ph.D.; Committee Member: Judith Ottoson, Ph.D.; Committee Member: Patricia Reeves, Ph.D. Part of the SMARTech Electronic Thesis and Dissertation Collection.

A mixed methods approach was applied to investigate horse health and performance in Pony Club horses. The qualitative phase (in-depth interviews) explored owners’ perceptions of horse health and performance, whilst the quantitative phase (prospective longitudinal study) identified key health and performance problems with associated risk factors in a cohort of Pony Club horses. Quantitative analytical methods included descriptive, logistic regression and negative binomial regression analyses. Data quality and therefore internal and external validity were improved by preceding the longitudinal study with the qualitative phase. Horse health was not a well defined concept among participants, preventive health care was rarely practiced and other routine health care were administered on an ad hoc basis. Owners of Pony Club horses were concerned about their horses’ welfare, but resorted to non-veterinary sources for advice on horse health. Farriers, chiropractors and equine dentists performed the majority of health care. This observed absence of veterinary involvement in preventive and routine health care matched owners’ perceptions of veterinarians as disease experts whom they consulted for emergencies or as a last resort. Coupled with the apparent absence of pre-purchase examinations these findings raise serious concerns about the veterinary impact on the health of Pony Club horses. It was concluded that opportunities exist to improve the veterinary involvement with Pony Clubs and facilitate the extension of appropriate horse health type information. The health of Pony Club horses was found to be suboptimal with musculoskeletal and dermatological problems the most common diseases identified. High prevalences of lameness and sore backs were observed, but owner sensitivity of their detection was extremely low. Several of the horse-level risk factors identified, including height and breed for lameness, and height breed and gender for sore backs, were only alterable at the time of purchase. This suggests that owners may be at risk of purchasing horses with existing disease conditions, particularly in the absence of a veterinary examination. Other risk factors for sore backs, including housing, exercise, and body condition score could be reasoned on biomechanical grounds. An important outcome of this study was the following definition of a healthy horse: one free from pain and mentally and physically fit to participate regularly in the full range of required activities. An inextricable link between horse performance, exercise and behaviour was revealed during in-depth interviews. Initial intentions of using misbehaviour as a surrogate measure of poor performance were discarded resulting in an investigation of poor performance associated with misbehaviour, but not poor performance attributable to factors other than misbehaviour. Horses were generally exercised infrequently during each month, and this varied with season, with individual sessions lasting less than one hour. In terms of horse fitness these infrequent riding days suggest lack of strategy towards improving horse and rider skills and fitness. Another key outcome was a universally applicable definition of horse performance for Pony Club horses: good performance is considered to have occurred when the horse meets rider expectations. This is the first time that incidence of misbehaviour and associated risk factors have been described in a population of horses. Misbehaviour was more common during schooling and competing relative to pleasure riding, and more than half of the misbehaviour events were considered dangerous. Horse height, breed, and rider age were identified as risk factors for horse misbehaviour with tall Pony breeds ridden by teenagers the most likely to misbehave. The results highlighted the need to consider non-veterinary stakeholders, such as riders and Pony Club instructors, in programs to reduce misbehaviour in Pony Club horses. The study horses were kept predominantly at pasture in paddocks. The pastures these horses grazed represented an underused nutritional resource. Dietary supplements were commonly fed and often in excess. Involving agronomists to improve these horse pastures and employing simple monitoring tools such as body condition scoring more effectively will reduce reliance on expensive supplemental feeds as well as reduce the risk of obesity related disorders. Furthermore, pasture improvement coupled with strategic pasture rotation of horses and other livestock offers prospects for internal parasite control through less reliance on anthelmintics. The incidence of colic was very low in study horses, possibly due to the predominantly pasture-based diet and lifestyle of study horses. However, this same diet may have contributed to the high frequency of laminitis. Laminitis affected 24% of horses for part or all of the study, with 85 % of affected horses suffering recurring lameness and / or laminitis. Purchase of horses with chronic laminitis must be carefully considered due to this high frequency of recurrence. These findings suggest that more regular veterinary contact with Pony Club horses is desirable and would provide opportunities for owners to obtain veterinary advice on preventive health care. This veterinary contact could commence with a pre-purchase examination, and continue with comprehensive annual health checks. To achieve this, Pony Club veterinarians may have to become pro-active in marketing services beyond the treatment of disease to this sector of the equine industry.

Low back syndrome affects 20% of people, and it is estimated that 30% of patients are unable to return to work after surgery. The monitoring of health care outcomes could improve the delivery of health services. The health performance conceptual framework, derived from the Donabedian model, was used to evaluate the functional outcome, clinical recovery, response to surgery, and physician performance of the surgical management of lumbar spine degeneration. A quantitative study (n=685) was undertaken using an administrative database in a repeated-measures design. The clinical and functional outcome improvements were analyzed using t tests. Surgical complexity on health outcome was examined with ANOVA. Predictors of patient satisfaction was explored using Pearson's correlation and regression analyses. The results demonstrated highly significant improvements in functional (mean change 30%; ODI=16.79 -± SD 19.92) and clinical recovery (mean change 50%; modified-JOA=6.983 -± SD 2.613) with surgery at 3 months; a >50% positive response to surgery; and a > 90% patient satisfaction, sustained over a 2 year period. Complexity of surgery did not impact health performance. Strong correlations between the health performance metrics were detected up to 6-months from surgery. Poor clinical recovery and persistent functional disability were predictive of patient dissatisfaction. The social change implications for health policy are that a constellation of health performance metrics could predict the potential for functional and clinical recovery based on presurgery disability while avoiding medical expenditures for procedures with no health benefit; aid in health quality monitoring, peer comparisons, revision of practice guidelines, and cost benefit analysis by payers.

Title: Experiance with joga for tennis coaches Objectives of work: The aim of my thesis is to analyze the possitive effects of yoga on the mental and physical health of tennis players. The data is gained by quality data collection methods. The secondary objective is, on the basis of information obtained from short interviews with coaches, to create a theoretical model of categorization. Method: In this thesis we used the method of interview and narrative interview. The data collected from the interviews, was used to create a theoretical model of categorization. A method of narrative interview with elements of the interview was used as a key method of collecting data from selected subjects. Results: Following numerous interviews with various subjets including coaches and trainers, I have come to the conclution, that yoga has a positive effect on the mental and physical health of tennis players. The main effects of yoga include: increased confidence and concentration on the court, accelerated healing, reduced pain in the spine (notibly in lumbar region), therefore increasing the flexibility of joints and improving the performance of players. In terms of categorization on the effects of yoga, both in mental and physical health of tennis players, I classified the effects into two major categories: the...